Basic Information
Provider Information
NPI: 1033559810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: NAM WOO
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1540 E 58TH ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112344102
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1540 E 58TH ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112344102
CountryCode: US
TelephoneNumber: 6462901582
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2013
LastUpdateDate: 06/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X665689NYY Nursing Service ProvidersRegistered Nurse 

No ID Information.


Home